Advance Care Planning
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Advance Care Planning: What works and can we do more?
 

 

Advance care planning is crucial in ensuring that we receive the type of healthcare we prefer when we reach our end of life. But few Australians have initiated or completed one. We look at the latest evidence and highlight what needs to be strengthened.

 

Advance care planning (ACP) is an important component of person-centred healthcare. It is an on-going process wherein we communicate our wishes on the type of care we want based on our values and preferences. 
 

ACP provides us with choice and control at a time when we have lost the capacity to voice our wishes. But despite its importance, few Australians have completed ACP or an advanced care directive (ACD). Positive views toward ACP do not necessarily result in more end-of-life conversations. 

 

Barriers

Part of our work at CareSearch and palliAGED is to assess evidence to support individuals, health professionals, policymakers and communities with informed decision-making. In our brief overview of recent evidence on ACP in the Australian Context, we identified barriers to implementation:

  • Cultural factors
  • Attitudes to death
  • Complexity of legislation 
  • Lack of institutional policies
 
 
 
Graph showing Number of High Level Publications on 'Advance Care Planning' chart. 2004 through to 2019 showing increasing trend from under 10 search filters in 2005 to almost 60 in 2018
Research on advance care planning has rapidly increased in the past 15 years.      
CareSearch and palliAGED regularly assess the latest evidence to support decision-making.

 

What works for whom?

The effectiveness of ACP promotion and implementation strategies depends on the specific context and the format of intervention. While many approaches to implementing ACP have shown promise, the importance of tailoring efforts to meet the needs of different populations has also become clear. 
Approaches that have shown some success include:
  • providing information or educational content for patients, caregivers, or professionals; 
  • using decision aids or communication strategies; 
  • interventions targeting a subtype of ACP  
  • Interventions using specialised forms of ACP
  • Interventions seeking to improve palliative or end-of-life care
Australian research suggests that females, persons aged 55 and over, and those who have experienced a major health scare are more likely to complete an ACD. 
 
Infographic: Benefits of Advance Care Planning. Helps ensure you receive care that is consistent with your beliefs, values and preferences. Helps lessen the stress, anxiety and depression of loved ones or family members. Reduces non-beneficial transfers to acute care and unwanted interventions, Can improve end-of-life care, and person and family satisfaction with care.
ACP can help patient, carers and their families as well as health professionals.
Source: Advance Care Planning Australia. What is advance care planning (208kb pdf). Heidelberg, VIC: Austin Health; 2018 Aug. 

 

What more can we do?

To strengthen ACP promotion and implementation programs, the evidence supports:
  • Whole of systems approaches that targets multiple sectors in parallel 
  • Culturally sensitive promotion approaches 
  • Addressing the complexity of current legislation 
  • Focusing on older people and potentially those who have experienced a major health scare
  • Providing ongoing opportunities for discussions among patients, families, and healthcare providers 
  Whole System Strategic Approach for Advance Care Planning: Legislation, Policy, Social and cultural beliefs of people, Organisations and health systems, Funding, Availability of skilled workforce
A whole system strategic approach to ACP targets multiple sectors in parallel.
Source: Jimenez G, Tan WS, Virk AK, Low CK, Car J, Ho AHY. Overview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons. J Pain Symptom Manage. 2018 Sep;56(3):436-459.

 

 

How palliAGED and CareSearch can support you

palliAGED and CareSearch support individual patients, carers and families; health professionals; educators and researchers; and policymakers by: 
  • Providing access to the latest evidence and trustworthy resources
  • Adding to the evidence base by supporting research 
  • Partnering with other organisations and projects
  • Identifying education and learning options
  • Promoting advance care planning  
  

Effective advance care planning begins with a conversation. Professor Jennifer Tieman, CareSearch Director, discusses why taking time to talk is important in this blog.


To help you find out more, click on the links and resources below